Let us start with the end in mind: “Just say no” to the governor’s attempt to rob the Fund for a Healthy Maine and gut the Healthy Maine Partnerships.

Having practiced internal medicine and community nursing in and nearby Franklin County for nearly four decades, we have personal experience with this hot-button issue.

We founded and, for four decades, led the Franklin Cardiovascular Health Program, on which the HMPs were modeled. With six others (including four Mainers), we co-authored a study about the Franklin Program that was published recently by the Journal of the American Medical Association.

The Franklin Community Health Model has been associated with excellent outcomes: improved health behaviors (especially successful smoking cessation) and cardiovascular risk factors (better control of hypertension and cholesterol); fewer hospitalizations; fewer deaths from heart disease, stroke and cancer; and more than $5 million savings annually in health care costs. Based on those findings, JAMA’s expert editorialists proposed consideration of the Franklin Community Health Model “for other communities to emulate, adapt and implement.”

In fact, here in Maine, that is what happened.

In 1997, we were invited to testify before the Maine Legislature’s Appropriations Committee on behalf of a proposal to commit the state’s tobacco settlement funds to create and, over the long-term, sustain a statewide network of community health programs, to be explicitly modeled after the Franklin program. That money became the Fund for a Healthy Maine, designated by legislative mandate to fund what are now 27 HMPs.

Understanding how the Franklin Program dealt with tobacco will help people visualize the sorts of approaches (including close collaboration with primary care physicians and community hospitals) that HMPs can utilize to achieve success.

Starting in the mid-1980s, the Franklin Program mounted a very successful, triple-pronged attack on tobacco: health promotion, disease prevention and chronic condition management. To promote health by education and policies in schools, Franklin facilitated collaborative anti-tobacco curriculum development by teacher-physician teams. Medical professionals (including all physicians on the hospital medical staff) taught tobacco-related topics in classrooms. At many worksites, Franklin promoted and helped develop policies and services for smoke-free workplaces, and conducted tobacco self-help classes for employees and families.

To reach the general community, Franklin promoted media advocacy for all of its ventures, including a successful campaign on behalf of smoke-free outdoor recreation facilities. Via Project ASSIST, Program staff supervised, while motivated high school students educated merchants and checked compliance with laws against sales of tobacco products to youth.

To prevent cardiovascular disease and other tobacco-related conditions, the Franklin Program conducted tobacco-related risk factor (including high blood pressure) screening clinics, with coaching, referral (to the Maine Tobacco Hotline) and follow-up in area schools, work sites and community settings.

The program facilitated adoption of smoking status as a routine vital sign in all health care settings, including medical practices. Program nurses conducted individual smoking cessation counseling and follow-up at school, work site, community and health care settings, with medication prescription and free dispensing at the latter.

How well did the Franklin Program do in getting current smokers to stop?

In the JAMA report, we displayed a graph showing smoking quit rates (former smokers/ever smokers) in 1) Franklin, 2) the other Maine counties, and 3) the United States.

In 1994-95 all three rates were statistically the same (about 52 percent). In 1996-2000, the Franklin Program’s tobacco initiatives had matured and the Franklin quit rate jumped to 70 percent — significantly better than the rest of Maine (58 percent), now better than the USA (51 percent), showing the early impact of the HMPs.

In 2001-2005, showing the increasing effectiveness of the HMPs, the rest of Maine rose to meet Franklin, and in 2006-2010, both Franklin (70 percent) and the rest of Maine (68 percent) were both significantly higher than the USA (60 percent).

Well done, Maine.

The Franklin Community Health Model presents us with a valuable lesson. More effectively than either alone, accessible, high-quality health care integrated with comprehensive community/public health measures will help overcome barriers to promoting wellness, preventing disease and managing chronic illness. The Fund for a Healthy Maine and the Healthy Maine Partnerships have relied on this premise.

Mainers need to preserve those, the only public health infrastructure we have. Now is not the time to withdraw support from made-in-Maine models that work.

Dr. N. Burgess Record and Sandra Record are now residents of Saco.


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